HomeMy WebLinkAbout0054 MOUNTWOOD ROAD - Health 54Y-M6untwood Road
Marstons Mills P
A = 125 021
i
I
i
I
i
TOWN qOF BARNSTABLE
LOCATION I M��^��'fN C R.�. SEWAGE #
VILLAGE MArJ4V^ M1 I1s ASSESSOR'S MAP & LOT ARf- Oa l
INSTALLER'S NAME&PHONE NO.
SEPTIC TANK CAPACITY !/Ui) GAL
LEACHING FACILITY: (type) a ' (V x 42r I" T-s (size) 2 4/•
NO.OF BEDROOMS 3
BUILDER OR OWNER R o� L.A/yi o1,A
PERMITDATE: COMPLIANCE DATE:
Separation Distance Between the:
Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet
Private Water Supply Well and Leaching Facility (If any wells exist
on site or within 200 feet of leaching facility) Feet
Edge of Wetland and Leaching Facility(If any wetlands exist
within 300 feet of leaching facility) Feet
Furnished by T-A Sg 1+1 en Y 7, ro,r
A Qa�k a
o a < -
1 a3 yaI
� � Y
3 yS
a ass
S0
30 41.6
No. �'- a`Z ,---
Fee
THE COMMONWEALTH OF MASSACHUSETTS Entered in computer:
Yes
PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS
ZIppricattou for Migooal *p!tem Construction Permit
Application for a Permit to Construct( )Repair( )Upgrade( )Abandon( ) O Complete System ❑Individual Components
Location Address or Lot No. -5y lm ou� w 0o J R�, Owner's Name,Address and Tel.No.M A p— 'as— P.�( Qa
/ G f3
Assessor's Map/Parcel 'I J� d 6 kAteV(A
�VI i1 r'ST�n 1
Installer's Nzyne,Addre s,and Tel No. J S'o®l of S -,SCS/Q Designer's Name,Address and Tel.No.
Type of Building:
Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder( )
Other 'Type of Building No.of Persons Showers( ) Cafeteria( )
Other Fixtures
Design Flow gallons per day. Calculated daily flow gallons.
Plan Date Number of sheets Revision Date
Title
Size of Septic Tank Type of S.A.S.
Description of Soil
Nature of Repairs or Alterations(Answer when applicable) 1-> ( OQX C-Z0AI(
Date last inspected:
Agreement:
The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system
in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certifi-
cate of Compliance has been issue y this Board ealth.
SignedWq Date _
Application Approved by Date
Application Disapproved for the following reasons
Permit No. 'oZC`� "may Date Issued (a )�
No. d �•i p`L� ,
Fee
THE COMMONWEALTH OF MASSACHUSETTS Entered in computer:
• Yes
PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS
ZIpplication for Miopo$al 6potem Construction Permit
Application for a Permit to Construct( . )Repair( )Upgrade( )Abandon( ) ❑Complete System ❑Individual Components
Location Address or Lot No. 1!57y M� �00 ) R�, Owner's Name,Address and Tel.No.M a�,— a f Pq r. L1-1
Assessor's Map/Parcel yYl�r Sion /ld0, � ,1I jS 0 G 6 kAry\O(� /3
:.J
Installer's Nye,Addre s and Tel No. od�"Id$ "S6 yQ Designer's Name,Address and Tel.No.
O N , &Mpu1
,���d
Type of Building:
Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder
Other Type of Building No.of Persons Showers( ) Cafeteria( )
Other Fixtures
Design Flow gallons per day. Calculated daily flow gallons.
Plan Date Number of sheets Revision Date
Title
Size of Septic Tank Type of S.A.S.
Description of Soil
Nature of Repairs or Alterations(Answer when applicable) i.> " OTC rZDA►
Date last inspected:
u
Agreement:
The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system
in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certifi-
cate of Compliance has been issu b this Board ealth.
P Y
Signe Date C
Application Approved by Date G
Application Disapproved for the following reasons
Permit No. Date Issued
---------------------------------------
THE COMMONWEALTH OF MASSACHUSETTS \
BARNSTABLE, MASSACHUSETTS u fox �e P A'
Certificate of Compliance
THIS IS TO CERTIFY that the On-site Sewage Disposal System Constructed( )Repaired Upgraded ( )
Abandoned( )by
at s`� Maun w fly cl MAf S'i 0n 10,11S has been construct d Taccordance
with the provisions of Title 5 and the for Disposal System Construction Pe�nit No. Z00.3 -2 L)8 dated � /0 3
Installer Designer
The issuance of�s dermit shall not be construed as a guarantee that the system/ iW63 n s/dtsi ne
. d.
Date ®i ' Inspector ( .
---------------------------------------
" a,,._� — c.) c7
No.�✓ 3 � Fee S
THE COMMONWEALTH OF MASSACHUSETTS
PUBLIC HEALTH DIVISION - BARNSTABLE., MASSACHUSETTS
lwizpozar 6potem Construction Permit
Permission is hereby granted U Mto Construct(� )Repair(�U,Pgrade( )Aban on
S / ( )
System located at Out Woo 2 R c! A44r �, ,n1,//1
and as described in the above Application for Disposal System Construction Permit.The applicant recognizes his/her duty to
comply with Title 5 and the following local provisions or special conditions.
Provided:Construction must be completed within three years of the date of thi ermr.
Date_:_ /U'3 Approved by�'�
COMMONWEALTH OF MASSACHUSETTS
EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS
DEPARTMENT OF ENVIRONMENTAL PROT 014-
RECEIVED
JUN262003
TOWN OF BARNSTABLE
HEALTH DEPT.
TITLE 5
OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM
PART A
CERTIFICATION
Property Address: 54 Mountwood Road
Marston Mills. MA 02648
Owner's Name: Rob&Michelle Lamora
Owner's Address: Same
Date of Inspection: June 10, 2003
Name of Inspector:(Please Print) James M. Ford
Company Name: James M. Ford Map: 125
Mailing Address: P.O. Box 49 Parcel. 021
Osterville,MA 02655-0049 Lot: 13
Telephone Number: (508) 862-9400
CERTIFICATION STATEMENT
I certify that I have personally inspected the sewage disposal system at this address and that the information reported
below is true,accurate and complete as of the time of the inspection. The inspection was performed based on my
training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP
approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000). The system:
✓ Passes
i Conditionally Passes
Ne ds urther Evaluation by the Local Approving Authority
r ..s
Inspector's Signature: Date: June 21, 2003
The system inspector shall subm copy of this inspection report to the Approving Authority(Board of Health or
DEP)within 30 days of completing this inspection. If the system is a shared system or has a design flow of 10,000
gpd or greater,the inspector and the system owner shall submit the report to the appropriate regional office of the
DEP. The original should be sent to the system owner and copies sent to the buyer,if applicable,and the approving
authority.
Notes and Comments
****This report only describes conditions at the time of inspection and under the conditions of use at that
time. This inspection does not address how the system will perform in the future under the same or different
conditions of use.
Title 5 Inspection Form 6/15/2000 page 1
Page 2 of 11
OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION (continued)
Property Address: 54 Mountwood Road
Marston Mills. MA
Owner: Rob&Michelle Lamora
Date of Inspection: June 10, 2003
Inspection Summary: Check A,B,C,D or E/ALWAYS complete all of Section D
A. System Passes:
✓ I have not found any information which indicates that any of the failure criteria described in 310 CMR
15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below.
Comments:
B. System Conditionally Passes:
One or more system components as described in the"Conditional Pass"section need to be replaced or
repaired. The system,upon completion of the replacement or repair,as approved by the Board of Health,will pass.
Answer yes,no or not determined(Y,N,ND)in the for the following statements. If"not determined",please
explain.
The septic tank is metal and over 20 years old* or the septic tank(whether metal or not)is structurally
unsound,exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the
existing tank is replaced with a complying septic tank as approved by the Board of Health.
*A metal septic tank will pass inspection if it is structurally sound,not leaking and if a Certificate of Compliance
indicating that the tank is less than 20 years old is available.
ND explain:
Observation of sewage backup or break out or high static water level in the distribution box due to broken or
obstructed pipe(s)or due to a broken,settled or uneven distribution box. System will pass inspection if (with
approval of Board of Health):
broken pipe(s)are replaced
obstruction is removed
distribution box is leveled or replaced
ND explain:
The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will
pass inspection if(with approval of the Board of Health):
broken pipe(s)are replaced
obstruction is removed
ND explain:
2
Page 3 of 11
OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION (continued)
Property Address: 54 Mountwood Road
Marston Mills. MA
Owner: Rob&Michelle Lamora
Date of Inspection: June 10, 2003
C. Further Evaluation is Required by the Board of Health:
Conditions exist which require further evaluation by the Board of Health in order to determine if the system
is failing to protect public health,safety or the environment.
1. System will pass unless Board of Health determines in accordance with 310 CNIR 15.303(1)(b)that the
system is not functioning in a manner which will protect public health,safety and the environment:
Cesspool or privy is within 50 feet of a surface water
Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh
2. System will fail unless the Board of Health(and Public Water Supplier,if any)determines that the
system is functioning in a manner that protects the public health,safety and environment:
_ . The system has a septic tank and soil absorption system(SAS)and the SAS is within 100 feet of a
surface water supply or tributary to a surface water supply.
The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply.
The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well.
_ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a
private water supply well". Method used to determine distance
"This system passes if the well water analysis,performed at a DEP certified laboratory, for coliform
bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and
the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided that no other
failure criteria are triggered. A copy of the analysis must be attached to this form.
3. Other:
3
Page 4 of 11
OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION (continued)
Property Address: 54 Mountwood Road
Marstons Mills. AM
Owner: Rob&Michelle Lamora
Date of Inspection: June 10, 2003
D. System Failure Criteria applicable to all systems:
You must indicate either`yes"or"no"to each of the following for all inspections:
Yes No
_ ✓ Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool
✓ Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or
clogged SAS or cesspool
✓ Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or
cesspool
✓ Liquid depth in cesspool is less than 6"below invert or available volume is less than 'h day flow
✓ Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number
of times pumped—
_ ✓ Any portion of the SAS,cesspool or privy is below high ground water elevation.
✓ Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface
water supply.
✓ Any portion of a cesspool or privy is within a Zone 1 of a public well.
✓ Any portion of a cesspool or privy is within 50 feet of a private water supply well.
✓ Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water
supply well with no acceptable water quality analysis. [This system passes if the well water analysis,
performed at a DEP certified laboratory,for coliform bacteria and volatile organic compounds
indicates that the well is free from pollution from that facility and the presence of ammonia
nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided that no other failure criteria
are triggered. A copy of the analysis must be attached to this form.]
No (Yes/No)The system fails. I have determined that one or more of the above failure criteria exist as
described in 310 CMR 15.303,therefore the system fails. The system owner should contact the Board of
Health to determine what will be necessary to correct the failure.
E. Large System:
To be considered a large system the system must serve a facility with a design flow of 10,600 gpd to 15,000
SPd-
You must indicate either"yes"or"no"to each of the following:
(The following criteria apply to large systems in addition to the criteria above)
Yes No
_ the system is within 400 feet of a surface drinking water supply
_ the system is within 200 feet of a tributary to a surface drinking water supply
the system is located in a nitrogen sensitive area(Interim Wellhead Protection Area-IWPA)or a mapped
Zone II of a public water supply well
If you have answered`yes"to any question in Section E the system is considered a significant threat,or answered
"yes"in Section D above the large system has failed. The owner or operator of any large system considered a
significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR
15.304. The system owner should contact the appropriate regional office of the Department.
4
r
Page 5 of 11
OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART B
CHECKLIST
Property Address: 54 Mountwood Road
Marston Mills, MA
Owner: Rob&Michelle Lamora
Date of Inspection: June 10, 2003
Check if the following have been done: You must indicate`yes"or"no"as to each of the following:
Yes No
✓ Pumping information was provided by the owner,occupant,or Board of Health
✓ Were any of the system components pumped out in the previous two weeks?
✓ Has the system received normal flows in the previous two week period?
✓ Have large volumes of water been introduced to the system recently or as part of this inspection?
✓ _ Were as built plans of the system obtained and examined?(If they were not available note as N/A)
✓ Was the facility or dwelling inspected for signs of sewage back up?
✓ Was the site inspected for signs of break out?
✓ Were all system components,excluding the SAS,located on site?
✓ Were the septic tank manholes uncovered,opened,and the interior of the tank inspected for the condition
of the baffles or tees,material of construction,dimensions,depth of liquid,depth of sludge and depth of scum ?
✓ Was the facility owner(and occupants if different from owner)provided with information on the proper
maintenance of subsurface sewage disposal systems?
The size and location of the Soil Absorption System(SAS)on the site has been determined based on:
Yes No
✓ Existing information. For example,a plan at the Board of Health.
✓ Determined in the field(if any of the failure criteria related to Part C is at issue approximation of distance
is unacceptable)[310 CMR 15.302(3)(b)).
5
Page 6 of 11
OFFICIAL INSPECTION FORM -NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION
Property Address: 54 Mountwood Road
Marston Mills. MA
Owner: Rob&Michelle Lamora
Date of Inspection: June 10, 2003
FLOW CONDITIONS
RESIDENTIAL
Number of bedrooms(design): 3 Number of bedrooms(actual): 3
DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 330
Number of current residents: 4
Does residence have a garbage grinder(yes or'no): No
Is laundry on a separate sewage system(yes or no): No [if yes separate inspection required]
Laundry system inspected(yes or no): No
Seasonal use(yes or no): No
Water meter readings,if available(last 2 years usage(gpd)): 2001 -63,000 gals.; 2002- 71,000 gals.
Sump Pump(yes or no): No
Last date of occupancy: Currently occupied
COMMERCIAL/INDUSTRIAL
Type of establishment:
Design flow(based on 310 CMR 15.203): gpd
Basis of design flow(seats/persons/sqft,etc.):
Grease trap present(yes or no):
Industrial waste holding tank present(yes or no)
Non-sanitary waste discharged to the Title 5 system(yes or no):
Water meter readings, if available:
Last date of occupancy/use:
OTHER(describe):
GENERAL INFORMATION
Pumping Records
Source of information: Pumped in 2002-per owner
Was system pumped as part of the inspection(yes or no): No
If yes,volume pumped: gallons--How was quantity pumped determined?
Reason for pumping:
TYPE OF SYSTEM
✓ Septic tank,distribution box,soil absorption system
Single cesspool
Overflow cesspool
Privy
Shared system(yes or no) (if yes,attach previous inspection records,if any)
Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be
obtained from system owner)
Tight Tank Attach a copy of the DEP approval
Other(describe):
Approximate age of all components,date installed(if known)and source of information:
Aug. 22178-per as built card
Were sewage odors detected when arriving at the site(yes or no): No
6
Page 7 of 11
OFFICIAL INSPECTION FORM -NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION (continued)
Property Address: 54 Mountwood Road
Marstons Mills, MA
Owner: Rob&Michelle Lamora
Date of Inspection: June 10, 2003
BUILDING SEWER(locate on site plan)
Depth below grade:
Materials of construction: _cast iron _40 PVC other(explain):
Jrsuc Distance from private water supply well tion line:
Comments(on condition of joints,venting,evidence of leakage,etc.):
SEPTIC TANK: ✓ (locate on site plan)
Depth below grade: 12"
Material of construction: ✓ concrete _metal _fiberglass _polyethylene
_other(explain)
If tank is metal list age: Is age confirmed by a Certificate of Compliance(yes or no): (attach a copy of
certificate)
Dimensions: 1000 gal.
Sludge depth: I"
Distance from top of sludge to bottom of outlet tee or baffle: 30"
Scum thickness: I"
Distance from top of scum to top of outlet tee or baffle: 9"
Distance from bottom of scum to bottom of outlet tee or baffle: 13"
How were dimensions determined: Measuring stick
Comments(on pumping recommendations,inlet and outlet tee or baffle condition, structural integrity, liquid levels
as related to outlet invert,evidence of leakage,etc.):
Tees were present. The liquid level was even with the outlet invert. There were no signs of leakage.
GREASE TRAP: None (locate on site plan)
Depth below grade:
Material of construction: _concrete _metal _fiberglass _polyethylene _other
(explain):
Dimensions:
Scum thickness:
Distance from top of scum to top of outlet tee or baffle:
Distance from bottom of scum to bottom of outlet tee or baffle:
Date of last pumping:
Comments(on pumping recommendations,inlet and outlet tee or baffle condition, structural integrity, liquid levels
as related to outlet invert,evidence of leakage,etc.):
7
• Page 8 of 11
OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION (continued)
Property Address: 54 Mountwood Road
Marston Mills, MA
Owner: Rob&Michelle Lamora
Date of Inspection: June 10, 2003
TIGHT or BOLDING TANK: None (tank must be pumped at time of inspection)(locate on site plan)
Depth below grade:
Material of construction: _concrete _metal _fiberglass _polyethylene'rother(explain):
Dimensions:
Capacity: gallons
Design Flow: gallons/day
Alarm present(yes or no):
Alarm level: Alarm in working order(yes or no):
Date of last pumping:
Comments(condition of alarm and float switches,etc.):
DISTRIBUTION BOX: ✓ (if present must be opened)(locate on site plan)
Depth of liquid level above outlet invert: Even
Comments(note if box is level and distribution to outlets equal,any evidence of solids carryover,any evidence of
leakage into or out of box,etc.):
The D-box was broken down structurally. A new D-box was installed(Permit No. 2003-248).
PUMP CHAMBER: None (locate on site plan)
Pumps in working order(yes or no):
Alarms in working order(yes or no)
Comments(note condition of pump chamber, condition of pumps and appurtenances,etc.):
8
• Page 9 of 11
. OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION (continued)
Property Address: 54 Mountwood Road
Marstons Mills, MA
Owner: Rob&Michelle Lamora
Date of Inspection: June 10, 2003
SOIL ABSORPTION SYSTEM(SAS): ✓ (locate on site plan,excavation not required)
If SAS not located explain why:
Type
✓ leaching pits,number: 2-6'x 6'(1000 Qal.)
leaching chambers,number:
leaching galleries,number:
leaching trenches,number,length:
leaching fields,number,dimensions:
overflow cesspool,number:
Innovative/alternative system Type/name of technology:
Comments(note condition of soil,signs of hydraulic failure,level of ponding,damp soil,condition of vegetation,etc.):
One pit(#4)was full up to the inlet pipe. The cover was Y below grade. The other pit 05)had 2'6"ofwater on the bottom. The
scum line was at the same level. There were no signs of failure. The bottom to grade was 9'.
CESSPOOLS: None (cesspool must be pumped as part of inspection)(locate on site plan)
Number and configuration:
Depth-top of liquid to inlet invert:
Depth of solids layer:
Depth of scum layer:
Dimensions of cesspool:
Materials of construction:
Indication of groundwater inflow(yes or no):
Comments (note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.):
PRIVY: None (locate on site plan)
Materials of construction:
Dimensions:
Depth of solids:
Comments(note condition of soil,signs of hydraulic failure, level of ponding,condition of vegetation, etc.):
9
•
Page 10 of 11
• OFFICIAL INSPECTION FORM -NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION (continued)
Property Address: 54 Mountwood Road
Marstons Mills, MA
Owner: Rob&Michelle Lamora
Date of Inspection: June 10, 2003
Map: 125
Parcel. 021
SKETCH OF SEWAGE DISPOSAL SYSTEM Lot. 13
Provide a sketch of the sewage disposal system including ties to at least two permanent reference landmarks or
benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building.
t
a a 3
l o13 lqob
3 y a ass y�
y y�.c� �a6
S 30 61.6
10
�' • Page 11 of 11
OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION (continued)
Property Address: 54 Mountwood Road
Marstons Mills. MA
Owner: Rob&Michelle Lamora
Date of Inspection: June 10, 2003
SITE EXAM
Slope
Surface water
Check cellar
Shallow wells
Estimated depth to ground water 30' +1- feet
Please indicate (check) all methods used to determine the high ground water elevation:
Obtained from system design plans on record-If checked, date of design plan reviewed:
Observed site(abutting property/observation hole within 150 feet of SAS)
✓ Checked with local Board of Health-explain: topographic and water contours maps
Checked with local excavators, installers-(attach documentation)
Accessed USGS database-explain:
You must describe how you established the high ground water elevation:
_Using the Barnstable topographic map and the Cape Cod Commission water contours map,the maps were showing approximately
30'+/-to ground water at this site.
This report has been prepared and the system inspected and passed as of the date of inspection. This report is
not a warranty or guarantee that the system will function properly in the future. There have been no warranties
or guarantees, either expressed,written or implied, relating to the system, the inspection and/or this report.
11
r
Commonwealth of Massachusetts
Executive Office of Environmental Affairs
Dept. of Environmental Protection
One winter Street,Boston,Ma. 02108 John Septic
D.E.P. Title V Se Septic htispector
P.O. Box 2119
Teaticket, MA 02536
(508)564-6813
WILLIAM F.WELD
Governor
ARGEO PAUL CELLUCCI
Lt.Governor
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION
54 Mountwood Rd.Marstons Mills 02048 Address of Owner: s �+ 98
Property Address: �aTy
Date of Inspection: 5119198 (If different)
Name of Inspector: John Gract Mrs.Morey
1 am a DEP approved system inspector pursuant to Section 15.340 of Title%(310 CMR 15.000)
Company Name,Address and Telephone Number: ®j
CERTIFICATION STATEMENT
I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate
and complete as of the time of inspection. The inspection was performed based on my training and experience in the proper function and
maintenance of on-site sewage disposal systems. The system:
x Passes This Inspection Is based on criteria defined In Title V
code 310 CMR 16303.My findings are of how the system is
_ Congubmit
sses performing st the time of the Inspection.My Inspection does
_ Neevaluation By the Local Approving Authority not Imply any warranty at guarantee or the longevity of the
Fail septic system and any of its components useful life.
Inspector's Signature: Date: 5119195
The System Inspector shallpy of this inspection report to the Approving Authority within thirty(30)days of completing this
inspections. If the system is a shared system or has a design flow of 10,000 gpd or greater,the inspector and the system owner shall submit
the report to the appropriate regional office of the Department of Environmental Protection.
The original should be sent to the system owner and copies sent to the buyer,if applicable and the approving.authority.
INSPECTION SUMMARY:
Check A, B,C,or D:
A] SYSTEM PASSES:
x I have not found any information which indicates that the system violates any of the failure criteria
defined as in 310 CMR 15.303. Any failure criteria not evaluated are indicated below.
COMMENTS:
B] SYSTEWCONDITIONALLY PASSES:
One or more system components need to be replaced or repaired. The system,upon completion
of the replacement or repair,passes Inspection.
Indicate yes,no, or not determined(Y, N,or ND). Describe basis of determination in all instances. If "not determined",explain why not.
The septic tank is metal, unless the owner or operator has provided the system inspector with a copy of a Certificate of
Co7hpliance(attached)indicating that the tank was installed within twenty(20)years prior to the date of the inspection, or
the septic tank,whether or not metal, is cracked,structurally unsound, shows substantial infiltration or exfiltralion, or tank
failure is imminent.The system will pass inspection if the existing septic tank is replaced with a conforming septic tank
as approved by the Board of Health.
(revised(W!M)
One Winter Street • Boston,Massachusetts 02108 • FAX(617)556-1049 • Telephone(617)292-5500
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION (continued)
Property Address: 54 Mountwood Rd.Marstons Mills 02048
Owner: Mrs.Morey
Date of Inspection:5119mit
_ Sewacte backup or,breakout.or, hiah.static water level observed.in.the distribution box is due to a broken,
or obstructed pipe(s)or due to broken,settled or uneven distribution box.The system will pass inspection if
(with approval of the Board of Health). Describe observations:
broken pipe(s)are replaced
obstruction is removed
distribution box is leveled or replaced
—The system required pumping more than four times a year due to broken or obstructed pipe(s). The
system will pass inspection if(with approval of the Board of Health):
broken pipe(s)are replaced
obstruction is removed
C] FURTHER EVALUATION IS REQUIRED BY THE BOARD OF HEALTH:
Conditions exist which require further evaluation by the Board of Health in order to determine if the
system is failing to protect the public health,safety and the environment.
1) SYSTEM WILL PASS UNLESS BOARD OF HEALTH DETERMINES THAT THE SYSTEM IS
NOT FUNCTIONING IN A MANNER WHICH WILL PROTECT THE PUBLIC HEALTH AND
SAFETY AND THE ENVIRONMENT:
Cesspool or privy is within 50 feet of a surface water
Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh.
2) SYSTEM WILL FAIL UNLESS THE BOARD OF HEALTH (AND PUBLIC WATER SUPPLIER,IF APPROPRIATE) DETERMINES
THAT THE SYSTEM IS FUNCTIONING IN A MANNER THAT PROTECT THE PUBLIC HEALTH AND SAFETY AND THE
ENVIRONMENT:
— The system has a septic tank and soil absorption system and is within 100 feet to a
surface of water supply or tributary to a surface water supply.
— The system has a septic tank and soil absorption system and is within a Zone 1 of a public watersupply well.
— The system has a septic tank and soil absorption system and is within 50 feet of a private water supply well.
— The system has a septic tank and soil absorption system and the SAS is less than 100 feet but 50 feet or more from a
private water supply well, unless a well water analysis for coliform bacteria and volatile organic compounds indicates that
the well is free from pollution from that facility and the presense of ammonia nitrogen and nitrate nitrogen is equal to or
less than 5 ppm. Method usedto determine distance (approximation not valid)
3)Other
D] SYSTEM FAILS:
You must indicate either"Yes"or"No"as to each of the following:
I have determined that the system violates one or more of the following failure criteria as defined in
310 CMR 15.303. The basis for this determination is Identified below. The Board of Health should be
contacted to determine what will be necessary to correct the failure.
Yes No
Backup of sewage in facility or system component due to an overloaded or clogged SAS or
cesspool.
Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged
cesspool.
SAS is in hydraulic failure.
(revised 04117)87)
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION(continued)
Property Address: 54 Mountwood Rd.Marstons Mills 02649
Owner: Mrs.Morey
Date of Inspection:5119199
D]SYSTEM FAILS(continued)
Yes No
Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool.
Liquid depth in cesspool is less than 6"below invert or available volume is less than 1/2 day flow.
Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s).
Numbers of times pumped
Any portion of the Soil Absorption System,cesspool or privy is below the high groundwater elevation.
Any portion of a cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply.
Any portion of a cesspool or privy is within a Zone 1 of a public well.
Any portion of a cesspool or privy is within 50 feet of a private water supply well.
Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no
acceptable water quality analysis. If the well has been analyzed to be acceptable,attach copy of well water analysis for
coliform bacteria,volatile organic compounds, ammonia nitrogen and nitrate nitrogen.
E] LARGE SYSTEM FAILS:
You must indicate either"Yes"or"No"as to each of the following:
The following criteria apply to large systems in addition to the criteria:
The system serves a facility with a design flow of 10,000 gpd or greater(Large System)and the system is a significant threat to
public health and safety and the environment because one or more of the following conditions exist:
Yes No
the system is within 400 feet of a surface drinking water supply
the system is within 200 feet of a tributary to a surface drinking water supply
the system is located in a nitrogen sensitive area(Interim Wellhead Protection Area(IWPA)or a mapped Zone 11 of a
public water supply well)
The owner or operator of any such system shall bring the system and facility into full compliance with the groundwater treatment program
requirements of 314 CMR 5.00 and 6.00. Please consult the local regional office of the Department for further information.
(revised 042707)
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART B
CHECLIST
Property Address: 54 Mountwood Rd.Marstons Mills 02648
Owner: I Mrs.Morey
Date of Inspection:5118198
Check if the following have been done:YOU must indicate either"Yes"or"No"as to each of the following:
,c_ — Pumping information was requested of the owner,occupant,and Board of Health.
x None of the system components have been pumped for at least two weeks and the and the system has been receiving normal
flow rates during that period. Large volumes of water have not been Introduced Into the system recently or as part of this
inspection.
x As built plans have been obtained and examined. Note if they are not available with N/A.
z The facility or dwelling was inspected for signs of sewage back-up.
x — The system does not receive non-sanitary or industrial waste flow.
X_ The site was inspected for signs of breakout.
x All system components,excluding the Soil Absorption System,have been located on the site.
x The septic tank manholes were uncovered,opened,and the interior of the septic tank was inspected
for condition of baffles or tees,material of construction,dimensions,depth of liquid,depth of sludge,depth of scum.
x The size and location of the Soil Absorption System on the site has been determined based on
— — The facility owner(and occupants, if different from owner)were provided with information on the proper maintenance of
Sub-Surface Disposal Systens.
x Existing information. Ex. Plan at B.O.H.
x Determined in the field(if any failure criteria related to Part C is at issue,approximation of distance is
— — unacceptable)[15.302(3)(b)]
(revised 04127187)
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION
Property Address: 54 Mountwood Rd.Marstons Mills 02648
Owner: Mrs.Morey
Date of Inspection:5119198
FLOW CONDITIONS
RESIDENTIAL: d!bedroom for S.A.S.
Design flow: 330 g•p
Number of bedrooms: J
Number of current residents: t
Garbage grinder(yes or no): No
Laundry connected to system(yes or no): Yes
Seasonal use(yes or no): No
Water meter readings,if available:(last two(2)year usage(gpd):
rda
Sump Pump(yes or no): No
Last date of occupancy: rda
COMMERCIAL/INDUSTRIAL:
Type of establishment: n1a
Design flow:0 gallons/day
Grease trap present:(yes or no) No
Industrial Waste Holding Tank present:(yes or no) N
Non-sanitary waste discharged to the Title 5 system:(yes or no) No
Water meter readings,if available: rda
Last date of occupancy: nra
OTHER:(Describe) rda
Last date of occupancy:
GENERAL INFORMATION
PUMPING RECORDS and source of information:
Pumped two years ago.
System pumped as part of inspection:(yes or no)No
If yes,volume pumped:0 gallons
Reason for pumping: nla
TYPE OF SYSTEM
x Septic tank/distribution box/soil absorptions system
Single cesspool
Overflow cesspool
Privy
Shared system(yes or no) (if yes,attach previous inspection records,if any)
I/A Technology etc.Copy of up to date contract?
Other:
APPROXIMATE AGE.of all components,date Installed(If known)and source Information:
20 yrs.old
Sewage odors detected when arriving at the site:(yes or no) No
(re0e00427)97). ,
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION (continued)
Property Address: 54 Mountwood Rd.Marstons Mills e2548
Owner: Mrs.Morey
Date of Inspection:5119198
SEPTIC TANK: x
(locate on site plan)
Depth below grade: V
Material of construction:x concreate_metal_FRP_Polyethylene_other(explain)
If tank is metal, list age nia . Is age confirmed by Certificate of Compliance No (Yes/No)
Dimensions: GeV"H57"w490"
Sludge depth:3"
Distance from top of sludge to bottom of outlet tee or baffle: 24"
Scum thickness:3"
Distance from top of scum to top of outlet tee or baffle:B"
Distance form bottom of scum to bottom of outlet tee or baffle: 14"
How dimensions were determined: measured
Comments:
(recommendation for pumping,condition of inlet and outlet tees or baffles, depth of liquid level in relation to outlet invert, structural integrity,
evidence of leakage,etc.)
Septic tank and all components are struchaa8y sound and functioning properly.Recommend pumping every two years.Recommend raising covers.
GREASE TRAP:
(locate on site plan)
Depth below grade: ria
Material of construction: _concrete_metal_FRP_Polyethylene_other(explain)
Dimensions: rda
Scum thickness:rda
Distance from top of scum to top of outlet tee or baffle:nfa
Distance from bottom of scum to bottom of outlet tee or baffle: Na
Date of last pumping;v.
Comments:
(recommendation for pumping,condition of inlet and outlet tees or baffles,depth of liquid level in relation to outlet invert, structural integrity,
evidence of leakage,etc.)
nra
BUILDING SEWER:
(Locate on site plan)
Depth below grade: 1w
Material of construction: cast iron x 40 PVC other(explain)
Distance from private water supply well or suction line"
Diameter: 4"
Qjmments:(conditions of joints,venting,evidence of leakage,etc.)
(revIsed OWNT)
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION (continued)
Property Address: 54 Mountwood Rd.Marstons Mills 02548
Owner: Mrs.Morey
Date of Inspection:5119198
TIGHT OR HOLDING TANK:
(locate on site plan)
Depth below grade: Ma
Material of construction:_concrete_metal_FRP_Polyethylene_other(explain)
Dimensions: nfa
Capacity: rda gallons
Design flow: rda allons/day
Alarm level:_n<a Alarm in working order?_Yes_No
Date of previous pumping:
Comments:
(condition of inlet tee,condition of alarm and float switches,etc.)
Ma
DISTRIBUTION BOX:
(locate on site plan)
Depth of liquid level above outlet invert: nia
Comments:
(note if level and distribution is equal,evidence of solids carryover,evidence of leakage into or out of box etc.)
rda
PUMP CHAMBER:
(locate on site plan)
Pumps in working order.(yes or no)No
Alarms in working order(yes or no)_Yea
Comments:
(note condition of pump chamber,condition of pumps and appurtenances, etc.)
rda
(revised 0027ST)
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION (continued)
Property Address: 54 Mountwood Rd.Marstons Mills 02648
Owner: Mrs.Morey
Date of Inspection:5119199
SOIL ABSORPTION SYSTEM (SAS):x
(locate on site plan,If possible;excavation not required,but may be approximated by non-intrusive methods)
If not determined to be present,explain:
rda
Type:
leaching pits,number: one 1000 gallon octogon leach pit
leaching chambers,number:nra
leaching galleries,number: rda
leaching trenches,number,length: rda
leaching fields,number,dimensions:rda
overflow cesspool,number:nla
Alternate system: we Name of Technology:_nra
Comments: (note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation, etc.)
Leach pRs and all components are structurally sound and funcdoning property.System never had more than Y ofwater In It,system now has 3"of water In h.
CESSPOOLS:
(locate on site plan)
Number and configuration: Na
Depth-top of liquid to inlet invert: rda
Depth of solids layer: rda
Depth of scum layer: rda
Dimensions of cesspool: rda
Materials of construction: rda
Indication of groundwater: We
inflow(cesspool must be pumped as part of inspection)
nla
Comments: (note condition of soil, signs of hydraulic failure,level of ponding,condition of vegetation, etc.)
n1a
PRIVY:
(locate on site plan)
Materials of construction: We Dimensions: nla
Depth of solids: rda
Corments:(note condition of soil, signs of hydraulic failure,level of ponding, condition of vegetation,etc.)
nia
(revised 04127)871
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
54 Mountwood Rd.Marstons Milts 02648
Mrs.Morey
5f79f98
SKETCH OF SEWAGE DISPOSAL SYSTEM:
include ties to at least two permanent references, landmarks or benchmarks
locate all wells within 100'(Locate where public water supply comes into house)
beA
c A
o All
/�B a
� c 30
BA v.
(nv1s.d04WffiT). say. ! o! 30
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
54 Mountwood Rd.Marstons Mills 02848
Mrs.Morey
5110128
Depth of groundwater 12,
Please indicate all the methods used to determine High Groundwater Elevation:
Obtained from design plans on record.
Observation of Site(Abutting property,observation hole, basement sump etc.)
Determine it from local conditions
Check with local Board of Health
Check FEMA Maps
Check pumping records
Check local excavators, installers
X Use USGS Data
Describe in your own words how you established the High Groundwater Elevation.(MUST be completed)
USGS maps and chants
(revis•d04)2TMT) page 10 of 19
LO CAT ION SEWAGE PERT NO.
VI L LAG E 007-1
'INS T A LI '.S -NIA ME "D;D R E S S
BUILDER OR OWNER
DATE PERMIT ISSUED 111
DAT-_E COMPLIANCE ISSUED
b ..,e_
.
t.
0
a
On7
No.---•....7-.: ... "� Fim$..f.(.�....................
THE COMMONWEALTH OF MASSACHUSETTS
OA RD OF MH EA TH
a `
OF
10`0I, 4t on for Disposal Works Tonstrurtion thrmit
is hereby made for a Permit to Construct ( " or Repair ( ) an Individual Sewage Disposal
AWJjcatio
syst
l
a
.. s..._ - - . . .............................................
t L�o ,`,/,_(�)o®nA�ddress _ /// or Lot No.
_.G......_.}.T_....-XLi� ----(:.------•----- __ .. .. _--•--___-•_-"" ._
`- caner Address
a ......•.... ..................... --^ .... ... ... . ....... •...................... -..........-......-..................
Installer Address
T of Building Size Lot_0_7_..6x_Y.3_'k----Sq. feet
Dwelling—No. of Bedrooms ________________________________Expansion Attic ( ) Garbage Grinder ( )
aOther—Type of 'Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( )
p' Other fixtures ._ _____.__
W Design Flow_..........5-0.....................'..gallons per person per day. Total daily flow____..............`�-®:.D............gallons.
. 94 Septic Tank—Liquid capacity/dons Length................ Width................ Diameter---------------- Depth................
x Disposal Trench—No. .................... idth............._ Total Length_... ._.__._ _._._ Total leaching area.................... ft.
Seepage Pit No..... .......... r_.........
- ........ Total leaching ar a�...i_0.�q.lsq. ft.
z Other Distribution box ( !,Dosing tank ) �G 2 /�- /s- 27
"" Percolation Test Resul Performed by...... __,_- ._.._ �. Date... �,-.1_ :.' 7.._..__..
1
Test Pit No. i s '____minutes per inch Depth of Test Pit __________________ Depth to ground water_____-__________.:......
fZ4 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................
W ----•I-------- ---- ----- ---• --
O n ��
Description of Soil = 1' 'ems � -•-----------•=--•............... -------- . . ......�
x
W
VNature of Repairs or Alterations—Answer when applicable..................................................................................•.............
---.......................................-....................................................................................................................................................--.....
Agreement:
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of iITI IE 5 of the State Sanitary Code— The undersigned further agrees not to place the system in
operation until a Certificate of Compliance has been issued by the
/fboard
`of health.
Sig d ...--- .... ----1 �i�•,�Z
Date
Application Approved By....--s�.-� ----------•----- -• -- - -
-1��•- -----------
Date
Application Disapproved for the following reasons-------------------------------------•---------------------------------------------------------------------•-----
......................................................-.......................................................................................•-•-------••------•---•----•-----•---•---•------•---------
-� Date
PermitNo......................................................... Issued........................................................
___
No.._..... ._.�''.�..... s FEB,!.._.' .._...............
THE COMMONWEALTH 6F MASSACHUSETTS
BOA RDRF__,'-.i EA TH
-------------- 7 a--74�_.�.".OF...... --------_-------
A ltration for Dig og al Marks Tonstrur#ion Famit
?application is hereby made for a Permit to Construct ( ` or Repair ( ) an Individual Sewage Disposal
Syst at j
4� .
.. Address or-Let.No...
................................... ............................................;
caner. �1 �. f Address � -.-
"5 .. /
«.- .....
a - ....
s r Address ++}}� t
d Type of Building Size Lot.U�.. ..................Sq. feet
aDwelling—No. of Bedrooms....... .................................Expansion Attic ( ) Garbage Grinder ( )
a Other—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( )
Other fixtures ...............
---------•---•------ --•---------------•------
W Design Flow.........�' .........................gallons per person per day. Total daily flow_.___.._._._.._.._"?. _.d............gallons.
WSeptic Tank—Liquid capacit/ lons Length................ Width................ Diameter................ Depth................
x Disposal Trench No ......... Width.............. ' :. Total Length Total leaching area....................sq. ft.
Seepage Pit No.-- .............. .._ - f Total leaching area...I.... sq. ft.
Z Other Distribution box ( )0 Dosing to . ) '°'�L /;t µ /.4'• ;07
'-' Percolation Test Resu s Performed by.___. I.. �_ Date...
a -,�-
Test Pit No. 1/4.4,"__._.minutes per inch Depth of Test Pit____________________ Depth to ground water._____...__.._....__._..
Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................
- -- s � �„
f ..
Description of Soil.......... , Z----;i--------V
� + --.•••... ---------
x
UW ••-•-•---••---------------------------•--------------•--•---.........----.........-----••-•-•--••-•---•-----•-•--------------•------•-.....---••---•••--•-•---•---•--••------•---•--•-•-•----------•---
Nature of Repairs or Alterations—Answer when applicable--------------------------------.................................................................
---.....................................................•-.........I ....................0............ -----------•------------------------------.....-----------
Agreement: K
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of TITLE 5 of the State Sanitary Code— The undersigned further agrees not to place the system in
operation until a Certificate of Compliance has been issued by the board of health.
Sig ed ... � ._.T. ... .........---- ..... /(PAay'
rDate
Application Approved By... ���� l +/'.-
Date
Application Disapproved for the following reasons:.............................
----------•.................................•....................
............
--•-------------------------••---------............---------------------....----------.....-•------------•••-•--...............••-•---•••••--•--••-•-----•---•-----••-•------••---••-•--•--•....•-•---
Date
PermitNo......................................................... Issued.......................................................
Date
THE COMMONWEALTH OF MASSACHUSETTS
BOARD HEALTH
g:1"OF.....!" ........: '
............. ......... . ................................
Tnrtifirate of TamptiFanre
THIS IS -0 CERTIFY t th endividual S wage Disposal System constructed (A) or Repaired ( )
bY.......... .................: ....••-• ....... ......... .... :---- --- --- ---•-- ---------
ns
at.......^.��.. .--3.....................................•.......:_:................. ---- -•-- �`..........."---- -----•-- -----•---------------
has been installed in accordance with the provisions of TEE 5 of The State Sanitary Code as described in the
application for Disposal Works Construction Permit No. ._..._ `_ __________________ dated_.../; ...............
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE
SYSTEM WILL FUNCTION SATISFACTORY.
DATE................................................................................ Inspector..........................................-----------------•---•---------•---------
C
THE COMMONWEALTH OF MASSACHUSETTS
BOARD C=EALTH
�./ f '
7r ..!....•..�•� ... A�� O ...
F........-. �r
No........ev. .. F E........................
isposFa ki (90n ernti .
Permission 's e y granted....... . .......... ..._... ..._._.
,� T
to Construo ( or R air ( fan Indi 'd Sea age ispo em
-•-•--
as Sh0at ' Street
can on the application for Disposal Works Construction it o _________________ Dated...l" __``,�
s �
ltsl� ---•------- --------------
DATE -
oard of He
---------•------•-------...................................................... '
FORM 12S HOBBS & WARREN. INC.. PUBLISHERS
I�.t Lam( Flow I tb +c 3 = 33U G.P•Z7. -�- E /��p2
330.t f=70 % - 4-q c?6.P.o.
' 20, l'32 SF
�7LSPo5A.� PiT - l,5{= loco Gam.
CL�.W15,t...L d>eE.A = l5b S.F. F
R,.�^,
8t>l'1-O vl AQ T ST=. /u clr--. L--C
c5D os=. t .b = Sa s P D.
TaTAt_ �E✓516�1 = 425
ToTQt_ �at��f r-c�w = 3W 6PD. TNTtj
t�1;CGDl_QTIOt,I �l�TE t��i�,1 2Miu 02 LESS. `z • -'�-• � ~ 12..
jc
,e=
Top Fwv =ioo.o
172
t.n� G OPT 5y7o
1 vao iu� �y
t 4r
Iuv. f `box 46 S roc IC>
I 000 95 ,Nv is,v.
-
P"T p'
►AuA
.
Snag w/as►.i�n
SToal� EL=�
' CE.tZTtF•tED pt..bT- F='L.l.��i
PIZO�'t L L o C A T 1 o tJ
1-Z• CL:GS �..!o Sc a.t.�- �C.AL C, �I I� �' �-AT� �� 1 r`7��7
G;tt„rz'rn=-{ T�4A-r T14c-. (ovQDA-TiolJ 5u0%,uIJ Pt4t�t �ZEr=i=cZcNc.0
L-l�.F�,t�,zsd�l GCan.lr'L�lS W I TF-t TNT 51 D�.t_l►-ate - �dT (�
cdt�.. C'Zdd
�Av D� Acres.
CJA'tt= _ B.&YTC1�. rti-` IJY1= t G.
REGIS'["GIZ�1�
TI-t�� 'n�_n�-1 1 �, 6JOT L�.A�7CO Ul.b /��.J OSTE2V1l.tL o IVCAS�i�
,s.ays���.;.n4_�.�� ��c�t_.>�_� � �Yt�e_ c:Fcs�r�, 5�-t�e�� n.t�t?t_t e_n.►-J�r
rb t7r_-..i'CC_Mcv(l l_o C t_�N�� k�t� tXa • !
•NOTE: ALL PIPES ARE TO BE 4" SCHEDULE 40 P.V.C. SECTION A -A i
�house
10' min. from ALL aunFT FRaM 1Tf �ZDISTRsuI1GNBoxsNAu BE Existing Foundation - to septiclma`.ndk Septic tank corers �t be o-eox cover �t be PROFILE VIER OF ADDITION TO LEACHING SYSTEM SET LEVFl FOR AT LEAST 2 FT. t2' CONCRETE COVER
^�:R+ej� ;+ ,�• a s�'rr
TOP OF FOUNDATION ELEV. 100.00 ( lrithin 6 in. of finished grode '
elfhin 6 In ofnrlehed grade
finds over septic Talc-99.00 Orode over D-Box- 99.00 over SAS MOO 3" of 1 1 2" WOlhed Peost , •:"
/e" - / KNOCKOUTSFv
3/4" to 1 1/2 " Washed Crushed Stan r �;.�
s SS' t2' INLET `, r
S 0.02 3 HOLE H-10 A\
4"PVC(CAPPED)INSPECTION PORT TO BE
. BOX 3' Me&M Cover Tap OF Stetwn-F]er �96.36 INSTALLED AND TO BE MINN 6'OF GRADE r _. : 0' 6'
N BIew1MN�i
10- EXIST. S-0.01 or Greater _ •`a °� Q' �/
oasr.PIPE g h 1,LH
J
S• • t66'
r 1" O 30 0.01'1- foot 0'Effective Depth 1.75'
FROM EXIST. IDUNDATION - a, SE 3 / g • ;.
1 QD o s PLAN SECTION CROSS-SECTION
FouNawTION-�
CONCRETE FULL o B m 01 s Units a 625' = 30'
o c M 0.83' (10 inches) f!W / ;.•
PROFILE 6 In.of 3/4--1 t/r o °�° 3 31.25 31
3 HOLE H-10 DISTRIBUTION BOX
SYSTEM 0 LE
c oompaded :tone > o o rn rn NOT TO SCALE min. fl / E
Not to Scale - c o • 37.25 coos P
> 3.5' 3.5' Effective Length mxaer+rd�eafsC,nleMelraT f f
-c -10. SOIL ABSORPTION SYSTEM (SAS) GENERAL NOTES
6 in.of 3/4'-1 1/2" 0
compacted stone O Effective Vkm INFILTATROR HIGH CAPACITY (H-20 LOADING)/ GEORGE O'BRIEN
NOTE: ALL COMPONENTS MUST HAVE RISERS TO WITHIN 6" BELOW GRADE C 1. Contractor is responsible for Digsafe notification, Verification of Utilities
0 m ' (OR EQUIVALENT) Not to Scale and protection of all underground utilities and pipes.
w Bottom
ater O NONE OBSERVED NOTE: OVERALL HEIGHT OF INFILTRATOR IS 18" /EFFECTIVE HEIGHT IS 10" 2. The septic tank and distribution box shall be set
level on 6 of 3/4"-1 1/2" stone.
3. Backfitl should be clean sand or gravel with no
stones over 3" in size.
4. This system is subject to inspection during installation
P E R C 0 LATE 0 N TEST _ 00 by Carmen E. Shay - Environmental Services, Inc.
_ - 5. The contractor shall install this system in accordance
Date Percolation Test: 1, 2 _ - with Title V of the Massachusetts state code, the approved plan
Test Pea rformed By. CARMENN E E.. SHAY,, R.S., C.S.E. ------------- and Local Regulations.
Results witnessed By. WAIVER (Per Barnstable B.O.H.) --�-- 6. If, during installation the contractor encounters any
EXCAVATOR: Shay Env. Svcs. soil conditions or site conditions that are different
Percolation Rate: Less Than 2 MPI 0 36" �� - 131.02' PL from those shown on the soil log or in our design
installation must halt do immediate notification be
Test Hole Test Hole f made to Carmen E. Shay - Environmental Services, Inc.
No. 1 No. 2 --' 0.50'
7. No vehicle or heavy machinery shall drive over the
DEPTH SOILS ELEV. DEPTH SOILS ELEV. -�' = =- septic system unless noted as H-20 septic components.
0 99.00 0 99.00 8. Install Tuf-TTte gas baffles or equals on all outlet tee ends.
Sandy Loam Sandy ,,dy -'---' 9. All Distribution Lines shall be 4' diameter Schedule 40 NSF PVC pipes.
10 YR 3/2 10 YR 3/2 - - • 10. All solid piping, tees & fittings shall be 4" diameter
TEST HOLE #2 Schedule 40 NSF PVC pipes with water tight joints.
0"-6" Ae 98.50 0•_g• Ae 98.50 Q�- •` � P P 9
=dy sand �0 37. y' • -i, ELEV.= 99.00 11. Municipal Water is Connected to ALL OF The Residence and Abutting
Loam Loam
Properties Within 150 Feet.
10 YR 3/6 10 YR sib THE PROPERTY LINES ARE APPROXIMATE AND
6'- •Medium/Coarse6 g•_ 36•Medium eCaere96•00 • TEST HOLE #1 COMPILED FROM THE SURVEY PLAN GENERATED BY
• �,•. ELEV.= 99.00 BAXTER do NYE, INC. of OSTERVILLE, MA
Sand Sond ENTITLED "CERTIFIED PLOT PLAN OF LOT 12 MOUNTWOOD RD. M. MILLS ,MA
2.5 Y 7/4 25 Y 7/4 0.50' Failed ® DATED DECEMBER 15, 1977
36"- 132 C, 89. 36"- 132 C, Leach Pit AND IS NOT INTENDED TO BE A SURVEY PLOT PLAN
O
IT SHOULD BE USED FOR NO PURPOSE OTHER THAN
PROJECT BENCH MARK THE SEPTIC SYSTEM INSTALLATION.
TOP OF FOUNDATION EXISTING LEACH PIT TO BE PUMPED OUT AND FILLED IN PLACE
ELEV. = 100.00 (Assumed)
3
EXIST. 1,000 GAL.
SEPTIC TANK co NOTE: ANY STRIPPED OUT SOIL CONTAINING LEACHATE
I I CO FROM THE EXISTING LEACH PIT TO BE DISPOSED
. L J OF AS PER BOARD OF HEALTH SPECIFICATIONS.
tb
Perc #1 • __ 1HERE ARE NO WETLANDS ARE PRES€W wrri IN 200. OF THE PROPERTY
Depth to Perc: 42" to 60"
Perc Rate= 2 MPI ASSESSORS MAP 125 PARCEL 020
Groundwater Not Observed
No Observed ESHWT EXIST. fee LEGEND
ADJUSTED H2O Elev. = None GARAGE
EXISTING
3 BEDROOM DENOTES PROPOSED
HOUSE 104X1
SPOT GRADE
2-16' MAIL ACCESS MANHOLES
DENOTES EXISTING
�.T,�•:-- ;'� f .:-;�---�:•':;• I I ( X 104.46 SPOT GRADE
_,1 o ---- ---- PL PRO
PERTY LINE E
J
- 99------ -- - 91 s PROPOSED CONTOUR
OLM ET
EXIST.
THE ACCESS COVERS FOR THE sEPTic TANK. I DRIVEWAY I o ---- -gq EXISTING CONTOUR
TT�THAN BE �BELOW FHN INISHED
NISHHED OF 20 117 COMPOWNT OS #1 Feet + -
FINISHED GRADE I I 4 DEEP TEST HOLE & j
STEEL REINFORCED PRECAST CONCRETE
PLAN VIEW INSTALL TUF-TI7E GAS BAFFLES OR EOUALs
S PERCOLATION TEST LOCATION
f-3-24' REMOVABLE COVERS� i 6 FOOT STOCKADE FENCE
4- r; I I 131.06'
3' min, d•oronee
-• •• Ir INLET F mfnT 2' min. kdt to outlet . =s = ------------------------------------
aunEr 98------------------- ---- ------ 98s _rs_7- _ - - - P LOT P LAN
it f b s r �W depth
OF PROPOSED SEPTIC SYSTEM UPGRADE
MO UNT WO 0 OD ROAD PREPARED FOR
- 4 -10- '- (40 FOOT RIGHT OF WAY) ROBERT & IRENE CAMBELL
CROSS SECTION END-SECTION
AT
TYPICAL 1000o SCALE
SEPTIC TANK
s #66 MOUNTWOOD ROAD
NOT
` MARSTONS MILLS, MA
Kitchen
Bath Both Bedroom
Design Calculations EXIST. � -rY REPARED BY:
A /���j E.
(� A
Number of Bedrooms: 3 Equivalent to 330 Gal./Day (330 Gal./Day Min. per Title GARAGE /Dining y✓N C11 Rl�l li N l� ILA►Htl Y
Garbage Grinder: No CA
Leaching Capacity Proposed: 330 Gal./Day Minimum (Mina Per Title V) o E
Septic Tank - 2 x 330 Gal./Day = 660 USE EXIST. 1,000 GAL Septic Tank Living Room Bedroom Bedroom S iA ENVIRONMENTAL SERVICES, INC.
SOIL ABSORPTION AREA: Using percolation rate of <2 min./Inch 10.
Bottom Area: 0.74 gal/sq. ft. x 372.5 sq. ft. = 275.65 gallons p 0� P.O. BOX 627
Sidewall Area: 0.74 gal./sq. ft. x 78.72 sq. ft.== 58.25 gallons 0 20 40 50 ST0' EAST FALMOUTH, MA 02536
Providing: 333.90 gallons _ _ �*.SANITAR�PN
MEM3 BE HOUSE FLOOR SCHEMATIC TEL/FAX 508-539-7966
Use: (5) INFILTRATOR HIGH CAPACITY H-20 UNITS, HAVING A 0.83' (10 INCHES) EFFECTIVE DEPTH, SCALE: 1„=20' DRAWN BY: CES DATE: APRIL 4, 2006
TO BE USED WITH 3.5' OF WASHED STONE ON THE SIDES, AND 3.5' OF WASHED STONE ,
ON THE ENDS. NO STONE UNDER. SCALE: 1 =20 PROJECT#SD891 FILENAME: SD891 PP.DWG SHEET 1 OF 1